Motion segment–sparing repair of symptomatic chronic pars defects

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The current standard of care for symptomatic chronic spondylolysis (SP) is a one-level posterior spinal fusion for defects at L-5 or direct pars repair (motion segment sparing) for more rostral SP in younger patients and if no disc degeneration or listhesis is present. Since many patients with SP undergoing operative repair are young, a procedure with the lowest biomechanical profile is desirable, and direct pars repair is recommended. The authors here explore the limits of direct pars repair.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A retrospective review of all patients who underwent direct repair of SP between 2002 and 2009 was performed. Data were analyzed for predictors of symptom relief and radiographic fusion failure.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of 49 patients, only 7 required a reoperation to treat clinical symptoms, and 6 of them were female (p = 0.049). In all cases of treatment failure, the patient had bilateral L-5 SP. Patients with a slip percentage as high as 30% experienced radiographic fusion and symptom relief. Disc degeneration (measured using the Modified Pfirrmann Scale) did not predict symptom persistence or radiographic fusion failure. Patients with high-grade disc disease experienced symptom relief. The authors found no predictors of treatment failure.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The number of patients undergoing motion segment–sparing fusions of symptomatic chronic SP can be safely increased to include patients with Grade I spondylolisthesis as well as high-grade disc disease. Female patients with bilateral L-5 SP and low lordotic angles may be better served by a posterior spinal fusion from L-5 to S-1.</jats:p></jats:sec>

Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial

“…With regard to the radiologic outcomes, the union rate of the pars defect was 52.0% (32/61) in the surgery group. This rate was somewhat lower than expected, as previous studies have reported an 80% to 90% union rate [5][6][7][8]10,11]. This may have occurred because of our strict criteria for determining union status.…”

“…Young patients with LBP because of spondylolysis are often managed conservatively with medication, physical therapy, and injection treatment [1,2,6,10]. However, some patients who do not improve with proper conservative PSIS, posterior superior iliac spine.…”

“…The DR technique was introduced in 1970 by Buck [16]. This technique has several strengths: relatively simple with fewer complications than fusion and leads to good pain improvement and functional and radiologic outcomes [3][4][5][6][7][8][9][10][11][14][15][16][17]. Although DR has been popularized for young spondylolytic patients who require surgical treatment, no previous studies with a highquality design have investigated whether DR leads to better outcomes in terms of pain intensity and function and whether it is superior to conventional nonsurgical treatment.…”

“…Most importantly, fusion surgery causes the affected segment to lose its natural range of motion and thus leads to adjacent disc degeneration [12,13], whereas DR theoretically preserves the motion of the affected segment and thus avoids adjacent segment problems. In addition, DR may lead to better functional and radiologic outcomes with a less-invasive technique than fusion surgery [3][4][5][6][7][8][9][10][11]14]. However, most previous studies in this area have been retrospective studies with small sample sizes [3][4][5][6][7][8][9][10][11][14][15][16][17]; so, clear information on the therapeutic outcomes of DR in lumbar spondylolysis, especially for young patients, is not yet available.…”

“…Fortunately, most patients with spondylolysis can be managed conservatively [1,2]. However, some do not respond to conservative treatment and eventually require surgical treatment, such as direct repair (DR) of the pars defect [3][4][5][6][7][8][9][10][11]. Recently, DR for spondylolysis has gained popularity because of its inherent strengths compared with other surgical treatment methods, especially fusion surgery.…”